Rheumatic Heart Disease
Rheumatic heart disease (RHD) is caused by damage to the heart valves and heart muscle from the inflammation and scarring due to rheumatic fever. Streptococcal bacteria cause rheumatic fever, which usually begins as a sore throat or tonsillitis in children.
Who are at risk?
Rheumatic fever mostly affects children in developing countries, especially where poverty is widespread.
- Chest Pain
- Heart Palpitations
- Breathlessness on exertion
- Breathing problems when lying down – Orthopnoea
- Waking from sleep with the need to sit or stand – Paroxysmal Nocturnal Dyspnoea
- Swelling – Oedema
- Fainting – Syncope
- Fever associated with infection of damaged heart valves
What happens to the heart in RHD?
The heart is a double pump with four chambers. Each chamber is sealed with a valve. The valves open and close in one direction only, preventing the blood from flowing backwards.
RHD often involves damage to the heart valves. Typically, the damaged heart valve cannot open or shut ptoperly. This interferes with the proper flow of blood through the heart. Without treatment, the damaged valve may continue to deteriorate.
- Heart failure. Heart is unable to pump blood effectively. The strain causes the heart to enlarge.
- Infection of damaged heart valves – infective endocarditis
- Stroke due to clots forming in the enlarged heart or on damaged valves. These clots then break off (embolise) and cause blockage in blood vessels in the brain.
- Physical examination – while a heart murmur (extra sound) may suggest RHD, many patients with RHD do not have a murmur
- Medical history – including evidence of past streptococcal infection
- Chest X-ray – to check for enlargement of the heart and or fluid in the lungs.
- Electrocardiogram (ECG) – to check if the chambers of the heart have enlarged or if there is an abnormal heart rhythm (Arrhythmia)
- Echocardiogram – to check the heart valves for any damage or infection and assessing if there is heart failure. This is the most useful test for finding out if RHD is present
- Treatment depends on the severity of RHD
- Hospital admission to treat heart failure
- Antibiotics for infection (especially of the heart valves)
- Blood-thinning medicine to prevent stroke or thin blood for replacement valves
- Balloons inserted through a vein to open up stuck valves – Valvuloplasty
- Heart valve surgery to repair or replace damaged heart valves
- Regular check-ups with a cardiologist
- Up-to-date flu (Influenza and pneumococcal) vaccinations
- Regular (preventative) antibiotic to prevent Group A Streptococcus throat infections
- Antibiotic treatment for sore throats
- Good dental hygiene (tooth brushing, dental check-ups) as oral bacteria entering the bloodstream can increase the risk of complications including inflammation of the heart’s inner lining
- Antibiotics – may be given to some people before dental or surgical procedures to prevent bacterial
- infection of the damaged areas of the heart
- Good prenatal care as pregnancy can make RHD worse